Degenerative Disc Disease Sciatica Lumbar Radiculopathy
Most people who come to me for low back or neck pain truly believe that it is their degenerative disc disease that is causing the problem. Since everyone has degenerative disc disease by the age of 40, this can't be the cause of the pain, since almost everyone at the age of the 40 has no neck or back pain. Honestly, degenerative disc disease even shows up in teenagers. Did you know that the most common reason that discs show up as degenerated on MRI's and CT Scans is dehydration? The discs are very sensitive to dehydration. Since most of us don't drink enough water, is it any wonder that so many people show up as having degenerative disc disease?
Why do you think so many people get disc surgery and have continued pain? Why do so many people get IDET (frying of the disc) and still have pain? The reason is the disc is not causing the pain problem the person is having. Sure, some people have degenerative discs that cause them pain, but the majority of people who have these diagnoses, have pain that is coming from another structure. What other structure?
Besides the nerve, the most painful part of the musculoskeletal system is probably where the muscles, ligaments, and tendons attach to the bone. The periosteum (outside of the bone) is very sensitive. This is where all these structures attach to the bone. So if a person has a ligament or tendon injury, it is almost always where it attaches to the bone. This can be amazingly painful. When a ligament is stretched, injured, or torn, the joint becomes unstable, since the ligaments provide stability for structures.
Why do people with low back pain have muscle spasms? Not because the discs are degenerated, because the discs do not provide stability to the lower back, the ligaments do. The muscles spasm in order to stabilize the back after a ligament injury. If you have neck or low back pain that is accompanied by muscle spasms, then think ligament injury. Since you are thinking ligament injury, then what treatment should you get to stimulate ligament repair? Prolotherapy! See this isn't so hard is it?
Everyone who has a pain radiating down the leg is diagnosed with sciatica. Okay, not everyone, just about everyone. Do you know that if a nerve is really pinched that you could barely have a conversation with me? You be wracked with pain. As it is now, your pain comes and goes. You may even have a tingling down your leg. No, it isn't your sciatic nerve getting pinched. You simply have a ligament in your lower back, such as the sacroiliac ligament that is not stabilizing your pelvis. The pain or numb feeling down your leg is a referral pain. It isn't a nerve getting pinched. If you can sit in a chair and raise your leg straight out in front of you without reproducing your pain, then most likely you have a ligament injury and not an injury to your sciatic nerve. (In other words, you don't have lumbar radiculopathy).
If you have more low back pain than leg pain, then most likely you have a ligament injury in your back and not a pinched nerve. If you are in pain but it isn't to the point of causing you to sweat, you most likely have a ligament injury, not a sciatic nerve getting pinched. If you can feel equally in both legs, in other words the numbness you feel isn't true numbness, because when someone touches your skin you feel it fine. It is thus numbiness. Numbiness is the sensation of numbness, but on physical examination your sensation (sense of touch) is fine. This is a referral sensation, generally from a ligament injury, not a nerve injury.
Lumbar Radiculopathy
The arguments against this diagnosis are the same as sciatica. If I suspect someone has lumbar radiculopathy, I generally have the patient get an EMG/NCV test to verify it. No, you can't verify a nerve is getting pinched by an MRI - See Knee Research Study or CT scan. It can suggest it. The actual physiological test to verify it is an electromyography/nerve conduction velocity test (EMG/NCV) on the nerves. Someone with a true lumbar radiculopathy typically has all of the below:
• More leg pain than low back pain
• 90% of the pain or greater is leg pain
• Pain gets to a 10 out of 10
• The pain is unbearable
• Even narcotic medications barely touch the pain
• True numbness or weakness in muscles
• MRI documentation of severe disc herniation or facet arthritis
Very seldom do I see people like that. Generally, they have bad pain, but they are talking to me fine. When I walk into the exam room to meet a new patient and they are laying down in the fetal position and in obvious pain, then I suspect lumbar radiculopathy. Since ligaments, like the posterior hip ligaments, sacrotuberous, and sacroiliac and lumbosacral ligaments refer pain down the leg, when someone has some referral pain down the leg and doesn't have the above signs/symptoms, then most likely I tell them they have a ligament injury. Once convinced they have a ligament injury, then the most logical treatment choice for them would be Prolotherapy.
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